Index
A
Accidental Death and Disability: The Neglected Disease of Modern Society, 18, 32, 75, 81
Accountability
fragmentation of EMS system and, 6, 83
importance of, 83
recommendations for performance indicator development, 11–12, 85
shortcomings of current system, 73, 83
Accreditation
of EMS system components, 85
national standardization of EMS personnel training, 125, 144
of paramedic education, 9
Acute Injury Care Research Agenda, 217
Advanced cardiac life support, 32
Advanced emergency medical technicians, 123
Advanced life support (ALS)
effectiveness, 164
field application, 21, 80, 209–210
fleet characteristics, 55
research efforts, 218
transport reimbursement, 47
Agency for Healthcare Research and Quality, 100, 105
research program, 208, 214–215
Air medical services
accreditation, 85
capacity and access, 161
coordination of emergency response, 10, 162
government oversight, 11, 161–162, 170
Hurricane Katrina response, 188
interfacility transport, 162–163
lack of coordination, 74
origins and development, 160–161
regional disparities, 24
roles and responsibilities, 161
Ambulance services
accreditation, 85
ambulance crashes, 20, 159–160
ambulance design, 159
design and capabilities, 27, 33
disaster preparedness funding for, 176
dynamic load-responsive deployment, 65
emerging technologies for, 163–164
hospital-based EMS, 58
information technologies for, 163, 164, 170
interfacility transport, 162–163
Medicare reimbursement, 47
national capacity, 158
origins and development, 32–33
performance measurement, 86
problems of hospital emergency department crowding, 40
in rural areas, 65
utilization, 83
See also Prehospital care;
Transportation of patient
American Board of Emergency Medicine, 9, 144
American College of Emergency Physicians (ACEP), 35, 78–79, 208
American College of Surgeons, 35, 78–79, 85
Anthrax, 181
Automated external defibrillators (AEDs), 16, 140–141, 218–219
Automatic crash notification, 16, 27, 63, 149, 155–157
Avian influenza, 178
B
Basic life support (BLS) transport
features, 158
fleet characteristics, 55
Medicare reimbursement, 47
training curriculum, 124
Battlefield Medical Information System Tactical (BMIST), 169
Biochemical weapons, 181–182, 193–194, 199–200
Bioterrorism Hospital Preparedness Program, 12, 100, 197
Blood substitute, 163
Bystander care, 65–66, 140–141
C
California
EMS system management, 35
model EMS and trauma system, 94–95
San Francisco EMS system, 39
Capacity, EMS
air medical services, 161
ambulance services, 158
goals for system, 5
local disaster preparedness, 194–196
national, 15
Cardiac arrest
incidence, 16
Public Access Defibrillation trial, 218–219
Cardiac Arrest Registry to Enhance Survival (CARES), 87, 217
Cardiopulmonary resuscitation (CPR)
citizen first responders, 65–66, 140
prehospital care research, 219, 220
Categorization
of emergency providers, 8, 79–80, 114–115
of trauma care capabilities, 78, 114–115
Centers for Disease Control and Prevention (CDC)
EMS-related programs, 44
National Center for Injury Prevention and Control, 36, 44, 46, 99–100, 217
Centers for Medicare and Medicaid Services
EMS reimbursement, 41
performance measurement activities, 88
recommendations for, 7–8, 114, 116
See also Medicaid;
Medicare
Centers for Public Health Preparedness, 181
Civil War, U.S., 32
Commission on Accreditation of Ambulance Services, 85
Commission on Accreditation of Medical Transport Systems, 85
Committee on the Future of Emergency Care in the United States Health System, 5, 24–25
Communications technologies and systems
automatic crash notification, 16, 27, 63, 149, 155–157
for coordination of care, 76–77
current model systems, 90
current shortcomings, 3, 10, 38, 164
disaster response, 182, 198–199
interoperability among EMS systems, 23, 27, 164–167, 171, 199
obstacles to improvement, 166
recommendations for, 10–11, 164–165, 171
September 11, 2001, terrorist attack responses, 183
telephone location tracing, 23
transmission of clinical information, 10
Voice over Internet Protocol, 154
Wireless Public Safety Interoperable Communications Program, 167
See also 9-1-1 systems
Confidentiality issues
Health Insurance Portability and Accountability Act requirements, 49–50, 113, 213
research and, 210, 213, 222, 223
Congress, recommendations for, 6–7, 13–14, 96, 115, 198, 202, 223, 224, 226
Coordination of care
communication requirements, 76–77
conceptual development, 34
current model systems, 90–91, 92, 93, 94
current shortcomings, 3, 10, 39–40, 73, 74–75
demonstration projects to promote, 97
efficiency of care and, 23
establishment of national agency for regulation and support, 6–7, 105–111
in pediatric intensive care system, 76
regional disaster response planning, 176, 196–198
role of Federal Interagency Committee on EMS, 44
in trauma system, 76
See also Regionalization of EMS system
Costs
benefits of regionalization, 8
Emergency Medical Services Cost Analysis Project, 215
enhanced 9-1-1 technology, 153, 154
Health Insurance Portability and Accountability Act compliance, 50
scope of EMS costs, 7
See also Economics
Crash Injury Research and Engineering Network (CIREN), 215, 216
Crossing the Quality Chasm: A New Health System for the 21st Century, 19
Crowding, hospital emergency department
payment incentives to reduce, 89
quality of care and, 40
D
Data Elements for Emergency Department Systems (DEEDS), 84
Defibrillators, automated external, 16, 140–141, 218–219
Delayed treatment
ambulance diversion and, 40–41
field stabilization and, 21, 80
response times in rural areas, 63
use of ambulance lights and sirens, 220
Demonstration projects
funding levels, 98
recipients of grants for, 96
recommendations for, 13–14, 96, 115
Department of Health, Education and Welfare (DHEW)
evolution of emergency medical care system, 33, 34
See also Department of Health and Human Services
Department of Health and Human Services (DHHS), 105
disaster planning and operations, 12, 196–197, 202
recommendations for, 7, 8, 11–12, 13, 79–80, 85, 107, 113–115, 169, 171, 196–197, 202, 224, 226
structure of EMS system support, 44, 99–100
See also Department of Health, Education and Welfare
Department of Homeland Security (DHS)
disaster preparedness funding, 12, 176, 192–193, 197–198
EMS funding and support, 43, 44, 46, 100, 176
establishment, 184
recommendations for, 12, 196–197, 202
Department of Transportation (DOT)
evolution of EMS system, 33, 34, 43, 99
recommendations for, 12, 196–197, 202
See also National Highway Traffic Safety Administration
Disaster Medical Assistance Teams (DMATs), 100, 186–187
Disaster response
accidental man-made disasters, 179
biochemical threats, 181–182, 193–194, 199–200
certification and licensure for EMS personnel, 13, 201
communications and information systems for, 182, 198–199
current readiness, 4, 43, 192–194
definition of “disaster,” 175
emergency support functions, 185
EMS involvement in regional planning, 176, 196–198
establishment of new lead agency for oversight and support, 108–109, 115
funding distribution, 12–13, 176, 192–193, 197–198, 202
goals for EMS systems, 27
homeland security funding, 43, 176
National Incident Management System, 184
natural disasters, 178–179, 193–194
recommendations for, 12–13, 196–197, 198, 200, 202
research funding, 221
risks for EMS workers, 182
shortcomings of current EMS and trauma systems, 175–176, 202
strategies for improving, 194–202
training, 13, 43, 176, 195–196, 200, 202
types of threats, 177, 192, 193–194
volunteer screening and coordination, 188
Dispatch of emergency services
compensation for dispatchers, 141
dynamic load-responsive deployment, 65
prearrival instruction for bystanders, 140
recognizing nonemergency calls, 141–142, 157
roles and responsibilities, 141
selection of equipment and personnel for response, 157–158
training for, 141
See also 9-1-1 systems
Dumping of uninsured patients, 48
E
Earthquakes, 178
Economics
challenges for EMS system, 41
cost-effectiveness of EMS interventions, 23
demonstration project grant funding, 98, 115
disaster preparedness funding, 12–13, 176, 192–193, 197–198, 202
dispatcher compensation, 141
EMS workforce salaries, 4, 42, 136
evolution of EMS funding, 2, 18, 31, 33, 34, 35, 41
fire-based EMS funding, 57
funding of new lead agency for EMS system, 110–111
homeland security funds, 43
9-1-1 systems funding, 151
patient transport costs, 48
possible negative consequences of regionalization, 78
recommendations for research, 7–8, 114, 116
research funding, 13, 208, 210, 214–217, 218, 220–221
state funding for EMS services, 52
structure of federal support for EMS, 43–48
See also Costs
Education. See Training of EMS personnel
Effectiveness of current EMS system, 20–21
Efficiency of care, 23
Elderly
EMS utilization, 46
future demand for EMS, 134
Emergency care, defined, 25
Emergency Management Assistance Compact (EMAC), 187–188
Emergency medical services (EMS)
definition, 25
scope of, 25
See also Emergency medical services system
Emergency Medical Services Agenda for the Future, 6, 24, 36–37, 75–76, 100, 120, 167–170, 208
Emergency Medical Services Agenda for the Future: Implementation Guide, 120, 122, 208
Emergency Medical Services at Midpassage, 19, 34
Emergency Medical Services Cost Analysis Project (EMSCAP), 215
Emergency Medical Services Education Agenda for the Future: A Systems Approach, 120, 122, 124, 125, 126–127
Emergency Medical Services for Children, 35–36, 98, 106, 216–217
Emergency Medical Services Outcomes Project (EMSOP), 215, 216
Emergency medical services system
development, 1–2, 6, 18, 31–37, 73–74
essential elements, 34
patient characteristics, 16–17
recommendations for establishment of national agency for, 6–7, 105–111
shortcomings of current system, 3–5, 14, 31, 37–43, 73
strengths of current system, 3, 16
Emergency medical technicians (EMTs), 2
compensation, 42
credentialing and certification, 124
disaster preparedness, 176, 200
national certification, 126
roles and responsibilities, 127
scope of practice model, 123
training, 211
Emergency Medical Treatment and Active Labor Act (EMTALA), 23, 48–49, 112–113
recommendations for, 113–114, 115
Emergency Medicine Foundation, 208
Emergency support functions, 185
Emergency Systems for Advance Registration of Volunteer Health Professionals, 188
EMS. See Emergency medical services
EMS Performance Measures Project, 84
EMS Systems Act (1973), 31, 34
Endotracheal intubation, 209–210, 219
England, 2005 terrorist attacks in London, 189–190
ENHANCE 9-1-1 Act, 151
Equipment and supplies, EMS
biochemical event response, 199–200
current supply and access, 149–150
emergency support functions, 185
local disaster preparedness, 194–196
needs, 149
technological advances, 149
See also Air medical services;
Ambulance services;
Communications technologies and systems;
Information technologies and systems
F
Federal Aviation Administration (FAA), 161, 162
Federal Communications Commission (FCC), 152–153, 154, 167
Federal Emergency Management Agency (FEMA), 100, 185–186, 187
Federal government
air ambulance oversight, 161–162
demonstration project granting agency, 98–99
disaster preparedness funding, 176, 192–193, 197–198
disaster response, 184–185, 201–202
EMS research funding, 208
establishment of new agency for emergency care system integration, 6–7, 98, 105–111, 115
evolution of emergency medical care system, 18, 31, 32–37, 41, 99
fragmentation of EMS support and regulation, 99, 102
interagency collaboration in EMS, 100–101
leadership in emergency care, 3
legislative framework of EMS system, 48–53, 112–114
to promote communications interoperability among EMS systems, 166, 167
research support, 208, 214–217
structure of EMS oversight and funding, 43–48, 99–100
See also specific governmental entity
Federal Interagency Committee on EMS (FICEMS)
future of EMS system leadership and, 6, 104–105
membership, 101
new lead agency for EMS system and, 109–110
Federalwide Assurance program, 213–214, 223, 226
advantages, 57
funding, 57
structure and operations, 56–57
Fire department first responders, 127, 158
Floods, 178
Florida EMS and trauma system, 93–94
Fragmentation of EMS system
current state, 3, 6, 18, 31, 38–39, 41, 73
disaster response, 176
federal support and regulation, 6, 99, 102
structure of federal oversight, 43
G
Grant payments to emergency care system
Centers for Disease Control and Prevention block grants, 44–46
demonstration programs for enhancing emergency care, 14, 96–99
disaster preparedness funding, 12, 46, 193–194, 198
federal block grants to states, 18
origins and early development, 34, 35, 36
private funding, 34
H
Health Insurance Portability and Accountability Act (HIPAA)
impediments to EMS in, 49–50, 113
implications for research, 20, 113, 210, 213, 222, 223
recommendations for, 113–114, 115
Health Level Seven, 84
Health, Medical Care and Transportation of the Injured, 32
Health Plan Employer Data and Information Set (HEDIS), 88
Health Resources and Services Administration
as demonstration project granting agency, 98–99
EMS system programs and offices, 35–36, 43–44, 44
performance measurement activities, 85
recommendations for, 13–14, 96, 115
research support, 208–209, 215, 216–217
Trauma-EMS Systems Program, 181
Healthy People 2010 initiative, 44–46
Highway Safety Act (1966), 31, 33, 43
Hospital-based EMS
bioterrorism preparedness, 44
disadvantages, 58
emergency department crowding, 40
employment, 132
establishment of new lead agency for oversight and support, 108–109, 115
numbers of, 55
problems in coordination with prehospital care, 39–40
structure and operations, 58
Hurricane Katrina, 175, 176, 178, 182, 185–189, 193, 194, 199, 201
I
Infectious disease
pandemics and outbreaks, 178–179
public health surveillance, 75
risks for EMS personnel, 20, 41–42, 137, 159
Information technologies and systems
for ambulance services, 163, 164, 170
for disaster response, 198–199
Health Insurance Portability and Accountability Act and, 49, 50, 113, 210, 213, 222, 223
interoperability among EMS systems, 164–165
National Health Information Infrastructure, 11, 169, 171
9-1-1 caller identification and location, 151–154
for performance measurement, 86
Wireless Public Safety Interoperable Communications Program, 167
See also Communications technologies and systems
Informed consent, EMS research and, 212–213, 222–223
Injury, accidental
data sets, 169
preventive interventions, 75, 217
as public health problem, 36
research needs, 19
Injury in America: A Continuing Health Problem, 36
Interagency Committee on EMSC Research (ICER), 100
Israel, 2001 building collapse in Jerusalem, 190–191
J
Joint Commission on Accreditation of Healthcare Organizations (JCAHO), 85
Jurisdictions of responders, 10, 23, 38–39
K
Korean War, 33
L
Leadership
current federal, 43, 52, 99–102
establishment of new agency for emergency care system, 6–7, 105–111, 115
Federal Interagency Committee on EMS for, 104–105
Hurricane Katrina response, 185, 187
to promote communications interoperability among EMS systems, 166
strategies for improving EMS system, 102–104
See also Medical directors, EMS
Licensure and credentialing
air medical services, 161
Disaster Medical Assistance Teams, 187
disaster response training, 13, 200–201, 202
emergency medical technician training requirements, 124
EMS personnel registration status, 130
EMS subspecialty certification, 9, 143–144
national EMS certification, 126–127
national scope of practice model, 122–123
reciprocity among jurisdictions, 123, 137
recommendations for, 9, 144, 202
shortcomings of current EMS training system, 41
state government oversight, 51, 123
volunteers in disaster response, 188
Longitudinal Emergency Medical Technician Attribute and Demographic Study (LEADS), 215
M
Maryland EMS and trauma system, 35, 90–92
Medicaid
EMS utilization, 52
payment incentives for performance improvement, 89
state agencies, 52
See also Centers for Medicare and Medicaid Services
Medical directors, EMS
payment incentives, 89
potential problems, 143
roles and responsibilities, 142–143
system performance research, 220
Medicare
emergency transport reimbursement, 7, 114
influence on EMS services, 48
payment incentives for performance improvement, 89
See also Centers for Medicare and Medicaid Services
Metropolitan Medical Response System, 100, 188–189
Military medicine, 31–32, 33, 160–161, 169, 191
Missouri, 60
Models of emergency care
historical and conceptual development, 34
hospital-based EMS systems, 58
local level, 53
recommendations for demonstration program, 13–14, 95–96
research needs, 42
staffing models, 60
systems currently in operation, 90–95
Mortality
air ambulance crashes, 61
ambulance crashes, 20, 159–160
ambulance diversion and, 40–41
automobile accident, 24
EMS workforce occupational fatalities, 137
Mouth-to-mouth ventilation, 1, 32
Mustard gas, 181
N
National Association of Emergency Medical Technicians, 35
National Association of EMS Physicians, 35
National Association of State EMS Officials (NASEMO), 35, 50–51, 52, 126–127
National Center for Injury Prevention and Control, 36, 44, 46, 99–100, 217
National Disaster Medical System, 186–187
National EMSC Data Analysis Resource Center (NEDARC), 217
National EMS Education and Practice Blueprint, 120, 122
National EMS Information System (NEMSIS), 168–169, 215
National EMS Research Agenda, 208–209, 215, 223, 224
National EMS Scope of Practice Model, 9, 201, 215
National Governors Association, 201–202
National Health Information Infrastructure, 11, 169, 171
National Highway Traffic Safety Administration
development of EMS systems, 36, 43, 99
EMS funding and technical assistance, 6, 52
9-1-1 systems management, 151, 155
performance measurement activities, 85
recommendations for, 8, 79–81, 114–115
research activities, 215
National Incident Management System (NIMS), 37, 184
National Institutes of Health (NIH), 44, 208, 214, 221, 224
National Quality Forum, 85
National Registry of Emergency Medical Technicians, 124, 126, 130
National Response Plan, 37
National Standard Curricula, 123–124, 125
National Trauma Data Bank, 169
9-1-1 systems
automatic crash notification, 155–157
caller identification and location, 23, 151–154
capacity and utilization, 2, 53, 63, 151
establishment of new lead agency for oversight and support, 108–109, 115
funding, 151
nonemergency calls, 141–142, 157
origins and development, 2, 150–151
performance measurement, 86
prearrival instructions, 54–55, 140, 219
strengths of current system, 16
structure and operations, 27, 53–54, 151
Voice over Internet Protocol, 154
O
Obese patients, 22
Omnibus Budget Reconciliation Act (OBRA) (1981), 35
Ontario Prehospital Advanced Life Support study, 218
Outcomes research
air ambulance effectiveness, 61–62
Emergency Medical Services Outcomes Project, 215, 216
Health Insurance Portability and Accountability Act and, 50
performance measurement, 86
prehospital interventions, 21, 163–164, 209
regionalization rationale, 77
P
Paramedics
disaster preparedness, 176, 200
recommendations for training standardization, 125–126, 144
roles and responsibilities, 127, 129–130
scope of practice model, 123
training for research, 211
Patient characteristics
challenges of special populations, 22–23
Medicaid utilization, 52
See also Elderly;
Pediatric care
challenges in EMS care, 22
coordination in intensive care system, 76
emergency transport patients, 16
EMS-C, 35–36, 98, 106, 216–217
prehospital endotracheal intubation, 209–210, 219
Pediatric Emergency Care Applied Research Network (PECARN), 216–217
Performance measurement
Cardiac Arrest Registry to Enhance Survival, 87
current EMS effectiveness, 20–21
demonstration project, 97
information technologies for, 86
key indicators, 86
National Highway Traffic Safety Administration assessments, 52
need for EMS system review, 18–19
patient-level data for, 86
private EMS system evaluation, 59
public perception of EMS system performance and, 84
quality aims for health care system, 19
recommendations for, 11–12, 85–86, 115
research needs for, 42
statewide EMS system evaluations, 36
See also Public reporting
Personal protective equipment, 199–200
Police first responders, 127
Prehospital care
bystander care, 65–66, 140–141
categorization of services, 79, 114–115
historical and technical development, 32–37
jurisdictional issues, 10, 23, 38–39
need for coordination, 9–10, 74
participation in National Health Information Infrastructure, 11
patient stabilization out of hospital, 21, 80
recommendations for protocol development, 8, 80–83, 115
recommendations for research, 13, 221, 224
research needs, 42, 163–164, 209–210
research rationale, 207
safety risks, 19
scope of, 15
strengths of current system, 16
transmission of clinical information, 10
See also Air medical services;
Ambulance services;
Dispatch of emergency services;
Emergency medical services system;
9-1-1 systems
Preventive Health and Health Services, 44
Preventive interventions
accidental injury, 36
coordination of EMS with public health agencies, 75
Public Access Defibrillation (PAD) trial, 218–219
Public health agencies, coordination between EMS and, 75
Public involvement
citizen first responders, 65–66, 140–141
self-triage, 83
Public perception of EMS system performance, 18, 83–84
Public reporting
of aggregate performance data, 12, 88
current state, 88
forms of, 87
importance of, 87
Public safety answering points, 53, 141, 151, 154.
See also 9–1–1 systems
Q
Quality of care
ambulance diversion and, 40–41
current system, 4
financial incentives for performance improvement, 88–89
measurement, 4
out-of-hospital stabilization, 21, 80
regionalization of services and, 77
R
Radioactive materials exposure, 181
Red Cross, 32
Regional flow of patients, 2
Regional variation in EMS systems
causes of, 95
medical oversight and review, 9
9-1-1 systems, 23, 150, 153–154
response time, 22
role of demonstration projects, 95–96
shortcomings of current system, 2, 53
strategies for enhancing emergency care and, 13
as strength, 53
structure of state government EMS oversight, 50–51
training of EMS personnel, 9, 125
workforce qualifications, 119
See also Rural areas
Regionalization of EMS system
categorization of emergency departments for, 8
characteristics, 99
current model systems, 91, 93–95
definition of “region,” 26
implications of Emergency Medical Treatment and Active Labor Act, 112–113
possible negative consequences of, 78
recommendations for, 8
in rural areas, 65
Reimbursement
efficiency of care and, 23
incentives for unnecessary transport, 88–89
Medicare and Medicaid, 44, 46–48
payment incentives for performance improvement, 89
recommendations for research, 7–8, 114, 116
state role, 52
Research
barriers to, 18, 210–217, 220, 222
current EMS knowledge base, 207, 208–210
data sources for, 210–211, 212–214, 223
demonstration program for enhancing emergency care, 13–14, 95–96
development of EMS system, 34
disaster preparedness, 221
establishment of new lead agency for EMS system and, 109
federal entities for, 208, 214–217
funding, 13, 208, 210, 214–217, 218, 220–221, 224
informed consent issues, 212–213, 222–223
infrastructure for, 210
needs. See Research needs
practice applications, 211
prehospital care knowledge base, 218–220
protections for human subjects, 213–214, 222
recommendations for, 13, 220–221, 223, 224, 226
regulatory environment, 210, 212–214, 222–223
strategies for improving, 27, 220–224
Research needs
cost-effectiveness of EMS interventions, 23
outcomes data, 21
prehospital interventions, 163–164, 209–210
shortcomings of EMS knowledge base, 4–5, 18, 27, 42, 208–210
Response times
ambulance diversion and, 22–23
causes of delay, 22
determinants of, 4
performance measurement, 86
in rural areas, 63
variation among EMS systems, 22
Rhode Island, 2003 nightclub fire in West Warwick, 190
Ricin, 181
Robert Wood Johnson Foundation, 34
Roles and Resources of Federal Agencies in Support of Comprehensive Emergency Medical Services, 19, 33
Rural areas
air medical services, 161
challenges for EMS systems, 42, 62–64
crash fatalities, 24
development of EMS system, 36
disaster response readiness, 200
disparities in care, 23–24, 62
EMS workforce characteristics, 132, 138
need for new workforce staffing models, 138–139
9-1-1 systems, 63
population trends, 138
regionalization of services, 65
response times, 63
role of EMS in, 66
strategies to enhance EMS, 65–66
transport costs, 48
volunteer-based EMS systems, 60, 62
S
Safar, Peter, 32
Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users (SAFETEA-LU), 6, 101
Safety
ambulance crashes, 20, 159–160
of EMS personnel, 19–20, 41–42, 136–137
risks in disaster response, 182
risks in prehospital emergency care, 19
Sarin, 181
Scope of practice, EMT and paramedic
definition, 9
September 11, 2001, terrorist attacks, 37, 38, 176, 183–185, 192, 198–199
Severe acute respiratory syndrome (SARS), 178
Smallpox, 181
Society for Academic Emergency Medicine, 208
Spain
ambulancias, 31
2004 terrorist attacks in Madrid, 190
State governments
air ambulance regulation, 161–162, 170
ambulance regulation, 159
Centers for Disease Control and Prevention block grants, 44–46
demonstration programs for enhancing emergency care, 14, 96
disaster planning and operations, 12, 201–202
Emergency Management Assistance Compact, 187–188
EMS personnel credentialing and
certification, 122–123, 124, 126–127, 201
evolution of EMS system, 35
licensing reciprocity between, 123, 137, 201
recommendations for, 9, 11, 12, 123, 126, 144, 162, 170
Structure of EMS systems
categorization of emergency providers, 79–80
establishment of new lead agency, 106, 107, 108, 115
federal oversight and funding, 6, 43–50, 99–101
hospital-based, 58
local decision making, 53
prehospital care research, 219–220
regional variation in EMS systems, 2, 164
research role, 207
state government oversight, 50–53
See also Fragmentation of EMS system
Surveillance, public health, 75
T
Terrorist attacks
disaster preparedness, 12, 192–193
hospital bioterrorism preparedness, 44
Madrid (2004), 190
National Response Plan, 184–185
research funding, 221
threat types and characteristics, 179–182
training for EMS personnel, 43
See also September 11, 2001, terrorist attacks
Texas EMS and trauma system, 92–93
Tornadoes, 178
Training of EMS personnel, 27
accreditation, 9
disaster response readiness, 4, 13, 43, 176, 195–196, 200, 202
dispatchers, 141
efforts to standardize, 120–121
EMS subspecialty certification, 9, 143–144
first responders, 127
graduation trends, 135
historical development, 33
national certification, 126–127, 144
national core content, 120, 121–122
national standard curricula, 123–124
origins and development, 32
recommendations for, 9, 125–126, 143–144, 144, 200, 202
scope of practice model, 120, 121, 122–123
settings for, 125
shortcomings of current system, 41
Transportation of patient
cost per transport, 48
disaster response, 182
Emergency Medical Treatment and Active Labor Act requirements, 112–113
incentives for unnecessary transport, 88–89
Medicaid reimbursement, 41, 52
Medicare reimbursement, 7, 47, 48
patient characteristics, 16–17
recommendations for protocol development, 8, 80–83, 115
shortcomings of current system, 3, 10
strengths of current system, 16
See also Air medical services;
Ambulance services;
Prehospital care
Trauma care
definition, 25
Trauma center definition, 25
Trauma system, coordination of care in, 76, 78–79
Trauma Systems Consultation, 79
U
Uniform Prehospital EMS Dataset, 168
Uninsured patients, 48
Urban Area Security Initiatives, 193, 194
URGENCY Decision Assist software, 156–157
V
Ventricular fibrillation, 21
Voice over Internet Protocol, 154
Volunteer-based EMS systems, 60, 62, 188
W
Washington state, Seattle EMS system, 38
Wireless Public Safety Interoperable Communications Program (SAFECOM), 167
Workforce, 27
ambulance working conditions, 159
calls per week, 132
career development, 136
challenges for EMS system, 41–42
efforts to standardize qualifications and requirements, 120–121
job satisfaction, 135
licensing reciprocity between jurisdictions, 123, 137
occupational fatalities, 137
registration status, 130, 133, 134, 137–138
roles and responsibilities, 127–130
rural EMS systems, 42, 63–64, 138–139
safety concerns, 19–20, 41–42, 136–137
staffing models, 60
variations in education and training, 119
volunteer-based EMS systems, 60, 137–139
See also Emergency medical technicians;
Medical directors, EMS;
Scope of practice, EMT and paramedic;
Training of EMS personnel
World Wars I and II, 32